Surgical treatment of children with severe forms of Perthes disease

Purpose. To analyze the immediate and intermediate results of using femoral aligning osteotomy combined with device-assisted joint decompression in children with Perthes disease. Materials and Methods. The results of treatment of 16 children with Perthes disease at fragmentation stage analyzed. Mean age during surgery was 7 years and 4 months (6-9 years). Joint distribution according to Catterall criteria: Group III – 9, Group IV – 7. Joint distribution according to Herring criteria: Group В/С – 10, Group С – 6. X-ray image conformed to Stage IV (в) according to Veselovskii classification in all cases. The technique of femoral aligning osteotomy in combination with non-articulation device-assisted decompression, tunnelization, subchondral cellular-and-tissue transplantation used. Mean follow-up was 3 years (2-5 years). Results. Functional outcomes according to McKey: Grade I – 13 joints, Grade II – 3 joints. X-ray results according to Stulberg: Grade I – 2 joints, Grade II – 8 joints, Grade III – 5 joints, Grade IV – 1 joint. The share of good outcomes was 63 %, unsatisfactory ones – 6.7 %. Conclusion. The technology presented can be used effectively in treatment of severe forms of Perthes disease as an alternative to known surgical interventions.